In the US and globally, marginalized, urban women are disproportionately affected by the mutually reinforcing epidemics known as the Substance Abuse, Violence and HIV/AIDS (SAVA) Syndemic. Gendered risk in the forms of intimate partner violence (IPV), sexual assault (SA), sexual exploitation that begins early in childhood sexual abuse (CSA), and later in transactional sex or sex work (SW) can accumulate and interact over time. Yet little research has characterized the most common, and the most hazardous, of these gendered risk constellations with respect to substance use trajectories, and behavioral and biologic HIV outcomes. The proposed secondary analysis seeks to 1) identify meaningful constellations of gendered risk (e.g., exposure to both IPV and SA) and their prevalence and stability over time, 2) evaluate the influence of gendered risk constellations on substance use behavior and trends over time, and 3) prospectively evaluate the influence of gendered risk constellations on HIV behavioral (unprotected sex) and treatment (viral suppression) outcomes in a large cohort of marginalized urban women at risk for and actively using drugs. To achieve these goals, the proposed secondary analysis leverages the ongoing, longitudinal Women's Interagency HIV Study (WIHS), the largest and longest-running HIV cohort study of women in the US. The investigative team brings long- standing expertise in substance use and HIV research and interventions with high-risk populations to support the transition of a junior investigator into substance use-related HIV research. Findings will inform a greater understanding of the lived realities of urban women, the intersections among gendered risk, substance use and primary and secondary HIV prevention outcomes, and refined intervention approaches to reduce the interwoven burdens of substance use and HIV among the most marginalized women.